national veteran association. Active soldiers were randomly chosen from two battalions of the Burundian army. Descriptives of both groups are shown in Table 2.1. The data for two active soldiers and one ex-combatant were excluded from analyses due to missing data in the main outcome variables.
Participation in the study was voluntary and all participants had to sign an informed consent sheet prior to the interview. In case of illiteracy, oral informed consent was collected. All participants agreed to take part in the research project. The ethics committees of the University of Konstanz, Germany and of the University Lumière of Bujumbura, Burundi approved the study. The active soldiers received no payment for their participation. A financial compensation equivalent to 5€ was paid to cover transportation costs for the ex-combatants. With respect to the special vulnerability of the population, anonymity and confidentiality were ensured through the electronic coding and storage of the data, which fulfilled the highest and most secure data encryption standards.
Table 2.1
Descriptives of active soldiers and ex-combatants
Variable Active soldiers
(n = 554)
Ex-combatants (n = 391)
Statistics
Former rebel, No. (%) 184 (33.21) 129 (32.99) χ2 (1, 945) = .01
Traumatic event types, M (SD) [range] 10.02 (3.10) [0-17] 13.64 (2.39) [6-19] t935.92 = 20.32***, d = 1.28
Childhood maltreatment, M (SD) [range] 0.48 (.82) [0-4] 1.06 (1.08) [0-4] t693.10 = 8.97***, d = .62
Self-committed violence, M (SD) [range] 4.04 (3.18) [0-13] 8.59 (3.23) [0-14] t943.00 = 21.57***, d = 1.42
2.3.2 Measures
Traumatic event types. Exposure to different types of traumatic events was assessed using a checklist of 19 potentially traumatic war-related and non-war-related events (e.g., assault by weapon, life-threatening accidents), which also included events from the checklist of the Posttraumatic Stress Diagnostic Scale (PDS; Foa, Cashman, Jaycox, & Perry, 1997). The checklist was a version of a previously published checklist (Neuner et al., 2004) that was adapted to the Burundian cultural context. It showed a high test-retest reliability (r = .73, p .001) and significant accordance with the Composite International Diagnostic Interview (CIDI) Event List (Ertl et al., 2010) in an earlier study of former child soldiers in the Great Lakes Region of Africa. The exact frequency of a specific traumatic event was not measured, as this is considered to be unreliable due to memory biases (Kolassa et al., 2010). Instead, the items were coded dichotomously. If a participant had ever experienced an event, this was coded as “1”, otherwise it was coded as “0”. As a measurement of trauma-load, the number of experienced traumatic event types was summed.
Childhood maltreatment. Exposure to different types of childhood maltreatment was assessed by means of four single items oriented on the common domains of childhood maltreatment (physical abuse, verbal abuse, neglect and sexual abuse, cp. e.g., Teicher et al., 2006). The items were coded dichotomously, as “1” if the participant had experienced a type of childhood maltreatment and as “0” if not. As a measurement of childhood maltreatment, the number of experienced types of childhood maltreatment was summed. The following questions were asked: “Have your parents/caretaker neglected you during childhood?”,
“Have your parents/caretaker regularly humiliated you verbally during childhood?”, “Have you been physically abused by your parents/caretaker during childhood?”, “Have you experienced a sexual assault by a family member/caretaker/friend or foreign person during childhood?”.
Self-committed violence. To measure self-committed violence, we systematically assessed 14 different types of perpetrated violence (e.g., mutilation, rape or killing). The items were coded dichotomously and were summed up to create a self-committed violence sum score.
PTSD symptom severity. Symptoms of PTSD were investigated using the PSS-I (Foa, Riggs, Dancu, & Rothbaum, 1993). The PSS-I is a semi-structured interview which consists of 17 items and has proven its validity in comparable East-African samples (Ertl et al., 2010).
The items correspond to the 17 symptoms of PTSD in the DSM-IV, divided into the three clusters of re-experiencing, avoidance and hyperarousal. The assessment of symptom severity refers to the last two weeks and is based on a 4-point Likert scale ranging from 0 (not at all) to 3 (five or more times per week/almost always). For analysis, a sum score of all symptoms was computed to assess PTSD symptom severity, with a possible range of 0 to 51. The PSS-I comes with good psychometric properties, with an internal consistency of Cronbach’s α = .86 (Foa & Tolin, 2000). In the present study Cronbach’s α was .94.
Appetitive aggression. To assess experiences of appetitive violence we used the Appetitive Aggression Scale (AAS), a semi-structured interview that has been used and validated in other comparable populations with more than 1600 participants (Weierstall & Elbert, 2011).
The AAS consists of 15 items regarding the perception of violence or appetitive aggression (e.g., ‘‘Is it exciting for you if you make an opponent really suffer?’’ or ‘‘Once fighting has started, do you get carried away by the violence?’’). The interviewer rated the level of the
2.3.3 Procedure
Interviews with the demobilized combatants were conducted at the campus of the Université Lumière in Bujumbura, Burundi. Interviews with the active soldiers were mostly conducted at the military camp Mudubugu (Bubanza province, Burundi), and a smaller number were conducted at other military camps in Gakumbu (Bujumbura rural, Burundi) and Bubanza province (Burundi). At the time of the study, the active soldiers were receiving a two-month training session in preparation for AMISOM. The training took place in these camps, with one battalion at a time. Six clinical psychologists of the University of Konstanz, four military psychologists of the Burundian army and six advanced students of clinical psychology from the University Lumière interviewed the participants. Interviews were conducted in Kirundi.
Non-local interviewers conducted the interviews with the help of six bilingual interpreters.
Different interpreters translated all questionnaires into Kirundi and back into English. The translations were discussed in detail with the interpreters before their application in the interview. All interviewers and interpreters had been trained in the concepts of mental disorders and aggression in an intensive six-week training session prior to data collection and also received permanent supervision to ensure data quality. The interviews lasted one and a half hours on average.
2.3.4 Data analysis
The Robust multiple linear regression analyses were conducted to investigate the prediction of PTSD symptom severity as well as appetitive aggression by the number of traumatic event types, childhood maltreatment and self-committed violence. The aforementioned predictors as well as all two-way interactions were included in the regression models. To identify potential differences between ex-combatants and active soldiers, group assignment was included in the model and dummy-coded using 0 for the ex-combatants and 1 for the active soldiers. The predictors were mean-centered to reduce potential multicollinearity (Kleinbaum, Kupper,
Nizam & Muller, 2008). In a first step, all variables were simultaneously entered into the model. In a second step, the insignificant variables were excluded in a stepwise manner. The final model was selected according to Bayesian Information Criterion (BIC, Schwarz, 1978).
All analyses used a two-tailed α = .05.